Headache

Bengaluru-based marketing professional Vyom Bachani, 38, gets a headache after any vigorous exercise—running, skipping or elliptical training—coupled with a surge in body heat. Sometimes a cool-down keeps it at bay, sometimes it does not. He never has headaches otherwise.

Exercise headaches typically occur during or after strenuous workouts. The blood-starved muscles of the head, neck and scalp require more blood for circulation during any kind of physical exertion, including exercise. This results in the expansion of blood vessels, causing an exertional headache.

Doctors categorise exercise headaches into primary and secondary. While primary headaches are usually harmless, secondary headaches can be life-threatening and needs immediate medical attention.

Primary exertion headache or PEH: The majority of headaches are primary, often seen in people in the 20-40 years age group. Migraine and tension headaches are the common types. An exercise headache is a type of primary headache, usually linked to vigorous training in the heat, high altitude or humidity. “Primary exertion headache (PEH) is more common among men than women and is caused by exercises,” says Chennai-based Dr Dobson Dominic, medical director, s10 Health Sports Lounge. “The pain usually comes on suddenly, could be unilateral or bilateral and is often pulsatile and lasts from 10 minutes to 48 hours. Nausea, vomiting, phonophobia [sensitivity to sound], or photophobia [sensitivity to light] are a few symptoms that could also appear with a headache,” says Dobson, who is also sports medicine consultant, Chettinad Academy of Research and Institute and program chairman, MMSC sports and exercise medicine, Texila American University. “An exercise headache is common in people who have a history of migraine or who do strenuous workouts,” says Dr P.R. Krishnan, consultant neurologist, Fortis Hospital, Bengaluru.

Secondary headache: A headache is secondary when an underlying condition causes the pain. While some secondary headaches such as cervicogenic headache are not harmful, a few are serious in nature. “There can be different types of secondary headaches depending on the cause,” says Dr G.P. Dureja, director, Delhi Pain Management Centre. “Secondary headaches are not common, but if they occur, they need urgent medical attention. When there are frequent headaches that disturb the daily routine or when it causes problems in hearing or vision, it indicates secondary headache,” says Dr G.N. Goyal, interventional spine and pain management specialist, Delhi.

Not just exercise

Various triggers are perceived to cause headaches. “Exercise could dilate the arteries or veins, which are pain sensitive. It is prevalent in people with internal jugular vein valve incompetence (IJVVI). IJVVI results in backward venous [blood] flow, which leads to brain congestion and increases pressure within the skull leading to a headache,” says Krishnan. “PEH occurs due to muscle constriction because of increased blood supply to the affected muscles. This causes muscle spasm resulting in headaches,” says Dureja.

Several factors could trigger a primary headache. “PEH is more likely to occur due to high altitude, change in weather, or if there is an intake of alcohol or caffeine before exercise. Dehydration, increased blood pressure, holding of breath while lifting heavy weight or incorrect neck position may cause an exertional headache,” says Dobson. Goyal says unhealthy diet, stress, and lifestyle that does not balance work and rest are some of the triggers.

Secondary headaches are serious. The underlying cause could be medical problems such as infections, blockages, bleeding and abnormalities. “Secondary headaches can occur due to intracranial bleeding, rupture of blood vessels in the brain. Here, the headache is accompanied by nausea and vomiting. Secondary headaches do not respond to conventional medicines,” says Dureja.

“Bleeding because of trauma or a medical condition like hypertension, or structural changes in the brain that are prone to rupture of the blood vessels can lead to secondary headache,” says Goyal. A cervicogenic headache is a common and under-diagnosed problem, he says, where the pain could start from the neck and involves back of the head or vice versa.

“When there is a severe headache, which peaks suddenly, known as a thunderclap headache, it is because of blood leakage in the brain. A headache which progressively increases and continues for more than 48 hours or severe one-sided headache indicates structural issues. Evidence of fever, weakness of limbs, trouble with speech or balance, loss of consciousness, seizure, or a headache that wakes a person from sleep, weight loss that occurs along with a headache are a few signs that indicate the need for urgent medical attention,” says Krishnan.

Goyal explains that nausea and vomiting are common in primary and secondary headaches. It is a red flag for a secondary headache if there is persistent vomiting. Seizures, changes in vision, hearing or speech are also a few warning signs of a secondary headache. “Seek medical attention if the frequent headaches are not responding to painkillers and rest,” says Dureja.

Block the way

Benign exertional headaches are manageable with lifestyle modifications and change in exercise routine. “You can reduce the occurrence of exertion headaches with good warm-up exercises, cooling and ventilation in training settings, adequate sleep, nutrition and hydration,” says Dobson.

Krishnan mentions that lowering the intensity of the workout and being well hydrated are useful in the prevention of exertional headaches. “Finding the headache trigger is very critical to managing a primary headache. A person can maintain a pain diary where he can log the severity, period, food taken, any other condition that he experiences during a headache. Such a journal is useful in narrowing down the cause and preventing primary headaches,” says Goyal. Relaxation techniques such as deep breathing, meditation and yoga help prevent primary headaches.

According to Dobson, following can help in avoiding PEH:

Breathe well: Avoid Valsalva maneuver (forceful exhalation with mouth and nose firmly closed) during multiple repetitions of weight lifting. Exhale during the positive phase (when you raise the weight) and inhale during the negative phase (when you lower the weight).

Neutral spine: Maintain a neutral spinal alignment to allow proper circulation through the arteries and veins. It is not essential to keep the back straight when you look up during a squat or a deadlift. Keep the neck and head in a neutral position.

Safety: Larger compound leg movements at the beginning of the workout are safer because exhaustion, exercise induced dehydration and peaking heart rate won’t trigger at the start of the training.

Fitness: Develop cardio respiratory fitness with regular cardiovascular training. General conditioning along with interval training reduces the risk of exertion headaches by developing a healthy cardiovascular system to handle stress. It is necessary to build proper cardiovascular health, stay hydrated and maintain a neutral spine.

Researchers have developed drugs that are aimed at preventing migraine attacks from occurring, rather than stopping the attacks once they have started.

These studies are the first to test monoclonal antibodies for the prevention of migraine, and both are directed against a relatively new target in migraine prevention, the calcitonin gene-related peptide, or CGRP.

Both are phase II studies, meaning larger studies are needed to confirm the results.

One study involved 163 people who had migraine from five to 14 days per month. They received either a placebo or a single IV dose of a drug called ALD403 and then were followed for 24 weeks. Those who received the drug had an average of 5.6 fewer migraine days per month, a 66-percent decrease, compared to 4.6 fewer days per month for those who received a placebo, or a 52-percent decrease. Sixteen percent of those who received the drug had no migraine days at 12 weeks, while none of those who received the placebo were free from migraine at that point.

In the other study, 217 people who had migraine four to 14 days per month received biweekly subcutaneous injections of either a placebo or a drug called LY2951742 for 12 weeks.

Those who received the drug had an average of 4.2 fewer migraine days per month at 12 weeks, or a 63-percent decrease, while those who received placebo had 3 fewer migraine days per month, or a 42-percent decrease.

Painkillers will do the trick for the occasional headache, but if you’re slammed with them on a weekly or even daily basis — as 45 million Americans are — you need a better solution. Here, proven strategies that can ease, and even eliminate, chronic headache pain

Rack open a window
When a home is well-sealed, indoor levels of mold, perfumes, smoke and other irritants can skyrocket, worsening headaches for one in four sufferers, according to research at Johns Hopkins University. An easy Rx: Open a few windows to air out those pollutants. Keep them open long enough for a refreshing breeze to sweep out stale smells. Repeat as necessary to circulate some fresh air throughout your home, study authors say.

Sneak in some ginger
Add 1/2 teaspoon of fresh ginger to your daily diet, and you could tamp down even chronic headaches within one week, say researchers at Connecticut’s Manchester Memorial Hospital. Credit ginger’s active ingredient, gingerol. Danish studies suggest this powerful anti-inflammatory that is chemically similar to aspirin blocks the formation of pain-triggering compounds called leukotrienes in the brain.

Tip: Use ginger to add a zesty dash of flavor to stir fries, rice dishes, soups, casseroles and dipping sauces, grate it over ice cream, or steep it to make a tea.

Sport sunglasses
One in three headaches are triggered — or made worse — by blasts of sunlight, say UCLA researchers. The reason? When bright light hits the delicate retinas in your eyes, it activates your brain’s pain nerves. To stay ache-free, slip on shades before you head outdoors on bright days, even if you don’t think you need them.

Sniff tangerine essential oil
Spend one minute three times daily relaxing and inhaling the tangy, sweet smell of tangerine essential oil, and you could reduce your risk of tension headaches in as little as one week, say Stanford University researchers. Tangerine’s aromatic compounds soothe the central nervous system, relax tight neck and scalp muscles, plus boost your brain’s production of a pain-soothing compound called gamma-aminobutyric acid (GABA), says Hyla Cass, M.D., author of Eight Weeks To Vibrant Health. Look for it in health and whole foods stores.

Avoid herbal slip-ups
If you use prescription pain medication to tame your worst headaches, check with your doctor or pharmacist before trying any herbal remedies. Surprising University of Utah research suggests that some of today’s most popular herbs — including ginkgo, ginseng, St. John’s wort and valerian — can counteract prescription pain meds, leading to nasty headache flare-ups.

Warm up before working out
According to Columbia University researchers, up to one in four headache-prone women are hit with brain pain within five hours of exercising if they jump into vigorous workouts without warming up. The culprit? Rapid changes in blood flow can trigger painful swelling of brain blood vessels. To prevent the problem, do your first 10 minutes of exercise at a leisurely pace, then gradually pick up the speed, Columbia researchers suggest.

Eat more vegetarian meals
When women pile their plates with fruits, vegetables, legumes and 100-percent whole grains, their headache frequency is reduced by 70 percent, and their attacks are 66 percent shorter and less painful, say doctors at California’s Loma Linda University. “These healthy carbs contain hundreds of natural anti-inflammatories that quickly lower the amount of headache-triggering inflammation your body produces,” says Neal Barnard, M.D., president of the Physician’s Committee for Responsible Medicine in Washington, D.C.

Sip mullein leaf tea
Drink 16 ounces of this herbal brew daily and you’ll tamp down blood vessel and scalp muscle inflammation, reducing your risk of headache flare-ups in as little as 10 days, say Stanford University researchers. Credit mullein’s rich supply of natural anti-inflammatories. Look for mullein leaf tea in whole-food stores and well-stocked department stores like Walgreens. It can taste a bit bitter, so sweeten to taste with sugar or honey.

Level out your estrogen
Almost 60 percent of women struggle with their worst headaches right before their periods hit. Called menstrual migraines, these headaches are set off by sudden estrogen dips. A quick fix: If you take birth control pills, Yale University researchers suggest asking your doctor about skipping the placebos so your estrogen levels can stay steady all month long. Not on the pill? Consider using an estrogen patch during your premenstrual week, so those pain-triggering hormone plunges don’t occur.

Get up with your alarm
Get your sleep, but don’t linger in bed. According to University of Texas researchers, 79 percent of headache sufferers are prone to pain if they lounge in bed too long — even if they’re getting roughly the same amount of sleep each night. “Changing your wake-up time has a huge impact on brain function, lowering your pain threshold and making your brain blood vessels a lot more likely to spasm,” explains Michael Smolensky, Ph.D., author of The Body Clock Guide to Better Health.

Tip: Set your alarm so you get up at roughly the time every day, even on weekends.

Treat your snoring
Almost 30 million Americans struggle with sleep apnea — short breathing pauses during sleep – which triggers loud snoring, daytime fatigue, and nasty morning headaches. Those lapses in breathing allow carbon dioxide to build up in the bloodstream, which is a powerful headache trigger, explain researchers at Columbia-Presbyterian Eastside. If you’ve been told you snore loudly or stop breathing during sleep, report it to your doctor. Columbia studies show treating sleep apnea can make morning headaches vanish in as little as two days.

Take melatonin
Even if you don’t have sleep apnea, it may be wise to take a natural sleep aid . In a surprising Brazilian study, when migraine-prone patients took 3 milligrams of melatonin 30 minutes before bedtime, their headache frequency (and the level of pain) was cut in half. For one in four subjects, this simple treatment erased their migraines within three months! Turns out this sleep-inducing hormone helps prevent one of the most common migraine triggers — the amount or quality of sleep people get each night.

Soothe stress with a little “me” time
Carve out 30 minutes each day to relax and unwind, and your headache attacks could be cut in half within two weeks, say researchers at Utah State University. “Making time to nurture yourself drastically cuts your production of pain-triggering stress hormones,” explains Jacob Teitelbaum, M.D., author of Real Cause, Real Cure. Try leisurely baths, deep breathing, yoga, napping or any other calming activity that fits easily into your schedule.

Tame rebound pain
If you’re getting at least three headaches every week, chances are good you’re struggling with rebound headaches (pain that flares every time painkillers wear off). To fix the problem fast, try switching to plain aspirin or acetaminophen. “Although most over-the-counter painkillers cause rebound headaches, those two are completely innocent,” says David Buchholz, M.D., author of Heal Your Headache. Make the switch, and your headache flare-ups could be cut in half within one week, he says.

When it’s time to see a doctor
If none of these solutions work, you probably have migraines and should see a doctor to get them under control.

According to Cleveland Clinic researchers, women with migraines often need preventive meds to really get their pain under control. Yet fewer than half of all migraine sufferers have been accurately diagnosed. If you have even one of these migraine symptoms, and at-home remedies haven’t made a dent in your misery, talk to your doctor about it:

Your headaches last 4 to 72 hours
You’d describe the pain as throbbing
Your headaches worsen if you make abrupt movements (like bending down to pick something off the floor)

You’re sensitive to light or sound, or feel nauseous, during headache attacks

Having a headache is no fun. We have all been there. A small twinge can soon turn into a headache, that can be mildly irritating to excruciatingly painful. But what are some of the main causes of headaches? This article will explore some of the reasons why headaches occur.

#1 Lack of sleep

You can normally tell that if you have had insufficient sleep that a headache will start. I know that is how it usually is with me. I can almost guarantee that if I have not had a proper night’s rest, I will wake up and throughout the day, a headache will form. The solution is simple. Just try to get to bed a little earlier and get plenty of sleep so that a headache does not form in the first place.

#2 Dehydration

By the time you find out that you are dehydrated, you will already be quite dehydrated. One of the signs of this is the onset of a headache. So if you have dry gums, smarting eyes and you know you have not been drinking enough water, you are also likely to develop a headache. If you get a headache as the result of dehydration, it will be a more intense headache, and harder to just shake off. Drink water throughout the day. Even if you have already developed a headache, drink plenty of water with the painkillers and continue to do so. It will help the medication kick in quicker and the headache should soon subside.

#3 Eye strain

How long has it been since your last eye examination? If you wear glasses or contact lenses, your eyesight may have changed and you may require a new prescription. One of the first signs you will get is a headache, as your eyes strain to see what is before you.

#4 Stress or anxiety

Do you worry about a lot of things that are going on in your life? Do you find it hard to cope with anxiety? These are both reasons why many people have a headache. A tension headache will often occur after the muscles around the shoulders and neck become tense. It is not pleasant to have to deal with a headache on top of stress and anxiety as well. Try to relax the shoulders and neck and deal with the issues that are causing you so much stress and anxiety. Do not keep it all bottled up. It will only increase stress levels.

#5 Medical reasons

Concussions and side effects from prescription medications are another reason why a person may develop a headache. See your doctor if you feel that you cannot cope with the headaches and ask about changing to another medication that will not leave you with bad side effects. A concussion is not a condition that can be dealt with straightaway. It may take some time to overcome it. A persistent headache may indicate a more serious underlying cause. Again, consult your doctor and be specific about the kind of pain you feel and how long it has been going on. The doctor will then be more able to treat you properly.

It is not possible to avoid all headaches. But you can help to lessen the effects of a headahce by taking the appropriate action. Some headaches seem to just appear for no apparent reason and with no warning. Make sure that when you do feel a headache developing that you have a reliable form of painkiller on hand to deal with the pain quickly. Try to lie down and close your eyes for a few minutes until you feel the pain lessen. Headaches are a nuisance, but they need not take over your life.

Doctors who specialize in treating head pain, such as chronic migraines, are the latest to list the procedures and treatments they think have risks or costs that may outweigh the benefits to patients.

The American Headache Society’s list is part of the Choosing Wisely campaign from the ABIM Foundation, a not-for-profit foundation established by the American Board of Internal Medicine. The campaign has seen cancer doctors, eye doctors and chest surgeons naming the overused or unproven practices their peers should avoid and patients should question.

The newest Choosing Wisely list was published Thursday in the journal Headache.

“The article and recommendations identify situations that are felt by experts to be cases where patients and doctors should think very carefully before they decide to use that particular treatment or intervention,” said Dr. Elizabeth Loder, an author of the new recommendations.

Loder is the president of the American Headache Society, and chief of the Division of Headache and Pain at Brigham and Women’s Hospital in Boston.

All tests and treatments have risks, Loder said. For example, imaging techniques such as CT scans expose patients to potentially cancer-causing radiation, and certain pain medications sometimes used to treat headaches are easy to get hooked on.

The goal of the recommendations is to encourage discussion between patients and their doctors about which tests are overall beneficial to patients, she said.

“The purpose is to start a conversation about situations, tests, procedures and interventions that do not necessarily benefit the patient, and sometimes can even cause problems,” Loder said.

To come up with the recommendations, Loder and her coauthors asked physician members of the American Headache Society (AHS) to identify tests and treatments they view as being used incorrectly or too often, and which methods of care had benefits too small to outweigh the risks.

The researchers evaluated more than 100 items suggested by AHS members, distilling the list down to five items based on current evidence.

The guidelines advise against imaging the brains of patients who get headaches that have not changed over time.

They also discourage the long-term use of over-the-counter pain pills to treat headaches, and recommend that physicians avoid using certain pain medications – opioids like oxycodone and drugs containing butalbital like Fioricet – for patients who get headaches often.

Finally, physicians should not perform computed tomography, or CT, on a patient with a headache when magnetic resonance imaging, or MRI, is available, except if it’s an emergency, the recommendations state.

The recommendations, Loder said, “are a nice distillation for patients when thinking about their care.” Patients and their families can use the guidelines to start a conversation with their doctor about the pros and cons of a given test or procedure.

“In addition to thinking about the good things that may come about from interventions, it’s also important to think about situations in which caution can be used,” Loder told Reuters Health.